TREATMENT

After a diagnosis is confirmed, a detailed clinical assessment is carried out by our expert multidisciplinary team. Your case will be presented at a multidisciplinary team meeting with collaborative discussion about the best possible treatment and outcomes for the case specific to your tumour. After the meeting, our specialists will meet with you to discuss their recommendations and provide a detailed explanation of possible treatment options. The final decision regarding the treatment and care plan is made in consultation with you. Cancer specialists work collaboratively to develop an individualised care plan for you and they are supported by oncology nurses and allied health professionals.
Our nursing team coordinators bring the team together and help guide you through your treatments while providing information about your condition, treatments and hospitalisation. All operating rooms at Macquarie University Hospital have been designed with new technologies in mind, and the hospital has a full suite of both standard and specialised equipment.

SURGERY

Surgery is the main treatment for bowel cancer and today most colorectal cancer surgery is performed by laparoscopic (keyhole) techniques. In about 20 to 30 per cent of cases, traditional open surgery will be required. Open surgery is required when the patient has had many previous operations or if the body habitus precludes laparoscopy. Sometimes if the tumour is very advanced, open surgery is necessary.

In laparoscopic surgery, the surgeon makes several small (5 mm) cuts in the skin and muscle of your abdomen, instead of making one large cut as you’d have with open surgery. The surgeon passes a long, narrow tube called a laparoscope, and other instruments, through the cuts. The laparoscope has a light on the end so the surgeon can look into your abdomen. They remove the tumour through as small a cut as possible. If your surgery can be done laparoscopically, you will have less pain and get back to normal more quickly. You may also leave hospital sooner.

Robotic surgery is also available at Macquarie University Hospital for some rectal cancers. This is similar in approach to laparoscopic surgery, but allows the advantages of minimally invasive surgery to be extended to difficult cancers deep in the pelvis.

Your doctor will talk to you beforehand about the risks and benefits of the different types of surgery

TYPES OF OPERATIONS

The type of operation you have depends on where the tumour is in your colon. How much your surgeon takes away depends on the exact position and size of the cancer. As part of the standard operation, your surgeon will also remove the lymph glands closest to the bowel, in case any cancer cells have spread there. Colon resections are generally right-sided or left-sided. If the right side of the colon is removed this is called a right hemicolectomy.

Right Hemicolectomy

If the left side of the colon is removed, this is called an anterior resection.

Anterior Resection

There are variations on these two procedures based on where the tumour is. When the tumour is in the rectum, the operation required is called a low anterior resection. When the tumour is more towards the middle of the bowel the operation required is known as an extended right hemicolectomy. After your surgeon removes part of the bowel with the tumour, he or she is usually able to join the ends back together. The join is called an anastomosis. Sometimes, to give the join time to heal, the surgeon brings a section of bowel upstream from the join out to the skin. This is called a stoma. If the small bowel is brought out onto the abdominal wall it is called an ileostomy. If the large bowel is brought out it is called a colostomy. This type of stoma is usually temporary and the ends of the bowel are joined back together in another operation three to six months later. This is called a stoma reversal. In the meantime, you wear a colostomy or ileostomy bag over the opening of the bowel, to collect your bowel contents. If the cancer is in the lower part of your rectum, it is sometime necessary to remove the anus as well as the rectum to get control of the cancer. This is called an abdominoperineal resection. Then the surgeon makes a permanent colostomy opening on your abdomen.

Abdominoperineal Resection

If cancer blocks the bowel. Usually surgery for bowel cancer is planned in advance, after tests have found the cancer. But sometimes the cancer completely blocks the bowel at the time it is found. This is called bowel obstruction. In this situation you need an operation straight away. This can be treated with an operation or a stent. The operations involved for bowel obstruction are very similar to those outlined above. However, the patient is more likely to require a stoma when the operation is performed acutely. A ‘stent’ involves the surgeon placing a device inside the bowel during colonoscopy and this device holds the bowel open so that it can work normally again. This may be a temporary procedure before definitive surgery or a permanent procedure if the tumour is incurable.

RADIOTHERAPY

Radiotherapy uses high-energy rays to kill cancer cells. In colorectal cancer radiotherapy is mainly used to treat cancer in the rectum. It is usually given before surgery. Radiotherapy in this situation lowers the risk of the cancer coming back later and may also shrink tumours making them easier to remove. Usually, you have radiotherapy at the same time as chemotherapy. 5FU (fluorouracil) or capecitabine chemotherapy makes cancer cells more sensitive to radiation. You usually have external radiotherapy every Monday to Friday for one to five weeks, depending on the size and type of cancer. Our radiotherapists attend our multidisciplinary meeting and will review your pre-operative imaging and decide with the surgeon whether radiotherapy is appropriate. You will then be given an appointment with the radiotherapist to discuss the risks and benefits of radiotherapy treatment.

CHEMOTHERAPY

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body. For rectal cancer you may have chemotherapy before surgery. You are likely to have this with radiotherapy (chemoradiation). The aim is to shrink the cancer, make it easier to remove during surgery, and make it less likely to come back after surgery. You may have chemotherapy after surgery for colon or rectal cancer. This treatment is to reduce the chance of the cancer coming back and is called adjuvant chemotherapy. You may also have chemotherapy as a treatment for bowel cancer that has spread to another part of the body.